Drawing on the author's three years' ethnographic
research of karaoke bar hostesses and male clients in the Chinese urban
sex industry, this paper argues that men's health practices are
impacted by the practices of entrepreneurial masculinity and the
development of social relationships with the state. In addressing the
ways in which men's health practices are impacted by social factors
rather than individual factors, this research has significant
implications for HIV intervention programs, which should be devised to
alter men's health practice through breaking the association of
condoms with authoritarian, top-down, and coercive family planning
programs and changing peer culture, peer behaviors, and peer worldviews
in men's workplaces including companies and government offices in
China.

Keywords: masculinity, sex industry, state power, health, China

**********

In addressing the epidemic of AIDS, the current dominant biomedical
model in public health explains health as stemming from individually
chosen lifestyles. Epidemiologists focus on individual health behavior,
apply value-neutral objectivity, and rely heavily on surveys as their
primary method of scientific study (Bastos, 1999; Frankenberg, 1994;
Hunt, 1996; Mann, 1996; Schoepf, 2001, p. 339). In so doing, they reduce
"understanding human health to the quantification and recording of
information regarding individuals within populations" (Lupton,
cited in Robertson, 2009, p. 5). Following the rational choice model,
public health studies assume that people engage in dangerous behaviors
because they fail to recognize the risk or underestimate the risk
involved in such behavior. It is assumed that if individuals are
informed of these risks, they will recalculate and abstain from such
behavior.

Public health literature in general exhibits three major
characteristics: First, it follows a methodology centered on the
investigation and analysis of "problem populations." Second,
it uses a "rational-choice" model of human behavior that
attributes high-risk behavior to inadequate knowledge. Third, it is
based on survey results from questionnaire responses.

This paper contends that this dominant biomedical approach
dismisses the fact that health behaviors are related to social
conditions and shaped by cultural systems and therefore is "unable
to deal concretely with the lived social realities" (Mann, 1996, p.
3; Parker, 2001). Eschewing the dominant biomedical model widely
employed in public health, this article adopts a more complex, socially
structured view of human behavior (see also Bolton & Singer, 1992;
Carrier, 1989; Flowers, 1988; Herdt & Boxer, 1991; Obbo, 1995;
Parker, 1987, 1988). I argue that the intricate relationship between the
state and male clients and the meanings of the entrepreneurial
masculinity are critical to understanding many male consumers'
decision-making about condom use and hence the social dimension of
HIV/AIDS (de Zalduondo & Bernard, 1995; Farmer, 1992; Gupta, 1993;
Micollier, 2004; Parker, 1991; Schoepf, 1992; Sobo, 1993, 1995a & b,
1998). Entrepreneurial masculinity is characterized by behaviors that
demonstrate risk-taking and control of the people that he interacts
with. The ideal entrepreneurial male is the one who exhibits the ability
to command in any given situation. This can be expressed in karaoke bars
through the manner in which a man controls the hostesses that he
interacts with.

Drawing on the author's three years' ethnographic
research on karaoke bar hostesses and male clients in the Chinese urban
sex industry, this paper argues that men's health practices are
impacted by the practices of entrepreneurial masculinity and the
development of social relationships with the state. It shows that
knowledge of AIDS does not always translate into rational behavior and
that interventions exclusively based on information on HIV/AIDS have
apparent limitations.

This paper is based upon my three years of ethnographic fieldwork
on male clients in the Chinese sex industry in the port city of Dalian,
in Northeast China. China's sex industry emerged in the wake of
economic reforms. During the Maoist era, prostitutes were sent to labor
camps for reeducation. In 1958, the Chinese Communist Party proudly
declared to the world that prostitution had been eradicated, and this
success was a symbol of China's transformation into a modern nation
(see Hershatter, 1997). Since the economic reforms of 1978, the
state's more lenient stance has opened the way for the reemergence
of nightclubs and other leisure sites. Visitors to these bars are mainly
middle-aged businessmen, male government officials, entrepreneurs, the
nouveau riche, policemen, and foreign investors (see also Uretsky,
2008). Clients can partake of the services offered by the hostesses and
at the same time cement social ties (ying chou) or guanxi (literally,
relationships) with their business partners or government officials.
Hostesses--mainly rural migrant women--play an indispensable role in the
rituals of these male-centered worlds of business and politics. (1)

This paper is comprised of five sections. The first section reviews
the literature. The second section explores research methods. The third
section investigates the historical evolution of masculinities in China.
The fourth section delves into the meanings of masculinities and social
relationships with the state that shape men's health practices. The
final section will summarize my conclusions.

GENDER, MASCULINITY, AND HEALTH

Anthropologists have observed that gender is a key organizing
principle of social relations. Among a wide array of sociocultural
factors that underpin health behaviors, it has been argued that gender
is one of the most important (Courtenay, 2000; Robertson, 2007;
Serrant-Green & McLuskey, 2008). (2) Gender not only influences
sexual behaviors, but also structures health issues.

Recently, there has been emerging feminist research focusing on
women and health (Bayne-Smith, 1996). However, few researchers have
dealt with how masculinities impinge on men's health (Courtenay,
2000; Robertson, 2006, 2007; Sabo, 1995; Serrant-Green & McLuskey,
2008; Verbrugge, 1985), and even fewer health scientists, sociologists,
and theorists identify masculinities as a risk factor (Courtenay;
Serrant-Green & McLuskey). It is only very recently that we see
emerging critical analysis of men's masculine identities and health
practices (see Robertson, 2007, 2009). It is crucial to demystify
men's risk taking behaviors and debunk biological determinism that
proclaims that men are biologically more prone to adopt unhealthy and
risky behaviors (see also Robertson, 2006, 2007).

Connell (1995) states that hegemonic masculinity is the culturally
dominant gender construction, which imposes power and authority upon
femininity and other forms of masculinity. Among the few researchers who
identify the linkage between masculinity and health, some demonstrate
that hegemonic masculinity is constructed through certain health
problems (Sabo, 1995). Others emphasize that men's health issues
stern from the practice of hegemonic masculinity, which is reinforced by
cultural norms. That is, men tend to adopt harmful behaviors to their
health and sustain health risks to uphold dominant masculine ideals
(Courtnay, 2000; Eisler, 1995; Neff, 1991; O'Neil, 1995; Pleck,
1994). (3)

While previous theoretical work is important, it is often not
grounded in empirical studies, and therefore fails to contextualize
men's health-related activities. To date, there has been very
limited empirical work that explores the linkage between masculinity and
health (Cameron & Bernardes, 1998, Chapple & Ziebland, 2002,
Grogan & Richards, 2002, Robertson, 2006; Watson, 2000; Williams,
2000).

In his evaluation of the existent research on men, health, and
masculinities, Robertson critiques the "striking absence of
knowledge grounded in the everyday experience of men themselves,"
the simplistic analysis of men as "cavalier, uncaring and
unconcerned about health matters," and the singular rather than
plural conceptualization of masculinities (Robertson, 2007, p. 1,2006,
2009). In his ground-breaking research on masculine identities and
men's health practices, Robertson (2006, 2007) critically explores
laymen's and health professional's own accounts to unravel the
ways in which social contexts shape masculinities and health practices.
Drawing on the empirical information and qualitative research, Robertson
argues that "men's own thoughts and behaviors" influence
their health experiences and health practices and "cannot be fully
understood outside of the social contexts within which they emerge"
(2007, p. 2). His research also problematizes masculinity through a
diversity of identities and differences among men and their health.

This paper follows this line of analytical inquiry and contributes
to this limited, yet important terrain of research in three ways. First,
this paper problematizes men and masculinity and recognizes the dramatic
shift in the meaning of masculinities, rather than accepting them as
immutable entities or unchanging norms. Through examining the ways in
which the specific historical and cultural context in China shapes
masculine identities, it "allows masculinities to be understood as
being historically contingent but not essentially determined and as
being fluid but hierarchical with dominant configurations acting
collectively" (Robertson, 2007, p. 34).

Second, this paper contributes to the literature of gender and
health by demonstrating the ways in which conceptualizations about
masculinities are translated into, and impinge upon men's
health-related activities.

Third" this ethnographic, in-depth study of men's lived
experiences sheds light on the nexus between masculinities and
men's health and furthers the current work on gender and health
that is still lacking in empirical data. Presenting men's own
narratives offers invaluable insights into the underlying complexities
of men's perceptions and understandings of health practices (see
also Robertson, 2007, p. 3). In demonstrating the contribution of
ethnography to the study of public health, gender, and sexuality, this
ethnographically contextualized study not only yields rich insights into
men's understanding of health practices, but also provides a unique
perspective on the study of disease transmission grounded in the
everyday lives and worldviews of clients and hostesses.

RESEARCH METHODS

Although surveys and questionnaires can be valuable in acquiring
general information, qualitative methods in ethnographic fieldwork are
far superior in foregrounding people's voices and illuminating
people's lived experiences, stories, and perspectives.

In this research, as illustrated below, a myriad of research
methods was employed to capture voices and accounts of research
subjects. An interpretative approach was utilized to shed light on the
intersection between masculinities and health-related activities. While
the karaoke bars shape masculine identities, men who enter them bring
with them hegemonic masculine rules that also shape and govern what is
deemed appropriate embodied masculine behavior (Hey, 1986; McDowell,
1999; Robertson, 2006; Uretsky, 2008, 2010). In the rest of the paper, I
will show how this normative masculine behavior has ramifications and
implications for detrimental health-related activities.

During my two-year fieldwork between 1999 and 2002, I lived and
worked with karaoke bar hostesses as a karaoke bar hostess myself. In my
previous book Red Lights, I discussed the trials and tribulations
throughout the fieldwork (Zheng, 2009). During this time, I lived and
worked with a group of hostesses working as a hostess myself in a
karaoke bar, facing many of the same dangers as they did and forming
strong, intimate bonds with them. The result was an ethnographic story
of young, rural women struggling to find meaning, struggling to shape a
modem and autonomous identity, and, ultimately, struggling to survive
within an oppressively patriarchal state system. During this period of
my fieldwork, I was deeply disturbed to find from my colleagues that
many male clients abjured the use of condoms. As a result, many
hostesses suffered from frequent abortions and STDs.

Upon the Institutional Review Board approval, I went back to the
field in the metropolitan city of Dalian in 2004, and conducted
fieldwork off and on for twelve months until 2007, on condom use, sex
work, and HIV/AIDS, among the same population of hostesses and male
clients. The site of Dalian was chosen due to my close relationship with
over two hundred bar hostesses and a hundred clients in the city from my
previous two years of intense fieldwork. To conduct this research, I
went back to the three karaoke bars I bad studied during my previous
fieldwork from 1999 to 2002. Through hostess and client informants from
my previous research, I resumed contacts with a bar owner and bar
manager, over fifty clients, and over fifty hostesses. As stated, the
sampling was of my previous informants, and the clients studied and
interviewed for this research were middle-aged businessmen, political
officials, police officers, entrepreneurs, and the nouveau riche.

Compared with surveys and quantitative research, ethnographic
research not only enhances the quality of the data obtained, but also
augments the quality of interpretation of the data. As a fieldworker, I
had actively engaged in the lives of the people, participated in the
daily activities, rituals, interactions, and events, and learned the
explicit and tacit aspects of their culture. This research method of
participant observation is superior because it helps the researcher
achieve both an emic and etic understanding of the participants'
point of view. Incorporating active participant observation with
personal stories, survey, questionnaires, and interviews of clients,
hostesses, and owners of adult health shops, this research allows the
voices of people at risk to be heard.

I engaged in long-term participant observation of interactions
between clients and hostesses, and I observed the everyday lives of
hostesses and the socializing activities of clients. I followed clients
and attended their group activities such as playing golf, singing songs
at karaoke bars, consuming at sauna bars and observing interactive
behaviors of male consumers and female hostesses, including dining at
restaurants, chatting at coffee shops and teahouses, and so on.

Aside from the fieldwork with the clients and hostesses, I also
served as a sales clerk at a local condom company in an attempt to
understand the condom market in the local area and committed a month and
a half to active participant observation as a counselor at a local AIDS
NGO to understand the local cultural milieu of AIDS organizations.

I designed a survey on HIV knowledge, condom use, and attitudes
toward AIDS patients for eight groups: hostesses, clients, female and
male hotel service workers, female and male college students, and female
and male professors. My intention was to compare and contrast the
answers and find out which group had the highest HIV knowledge.

To conduct interviews, for my own safety and the privacy of male
consumers, I invited my informants to coffee shops and restaurants for
interviews. Individual tables at coffee shops were pretty secluded and
quiet, as were the rented rooms at restaurants, which provided ideal
places for interviews on sensitive topics.

My interview questions were intended to better contextualize and
situate their survey answers. I started out with questions that tested
their HIV knowledge and the source of their knowledge, followed by
questions about the source of their sexual education, their opinions
about their sex education, their first sexual experience and condom use,
and their sexual history. I asked when they started using protection,
whether they were consistent in their practice of protection, their
definition of sex and their control over sexual desires, the setting and
occasion of their first intercourse, and subsequent sexual exchanges and
so on. (4)

Undoubtedly, these questions generated an immense embarrassment and
hesitation in the interviewees. The interviewees, understandably, were
red-faced and smoking the whole time to cover up their embarrassment.
Among all these questions, clients were most resistant to the topic of
HIV/AIDS and condom use. Due to the sensitivity of interview topics, I
never used recorders that could potentially exacerbate
interviewees' nervousness and disrupt the conversation flow. I
jotted down details during interviews and typed the entire interviews
into the computer after each interview.

I have combined participant observation with formal and open-ended,
as well as informal, interviews and surveys. Matthew Gutmann (2007, p.
27) observes, "There are practical limits to studying sexuality and
sexual relations." In this study, the limitations include selection
bias and reliance on self-reporting of sexual behaviors.

As stated, the hostesses and clients who participated in my
research were my previous informants and their friends. Given the
sensitivity of the topic, I relied heavily on these key informants with
whom I had developed a close relationship over the past decade. Because
of this particular selection process of my research subjects, I was not
able to reach a vast number of hostesses and clients in the city. This
recruitment bias circumvented the breadth of research subjects and,
hence, could potentially affect research findings.

Like all other researchers on sexuality, we are confronted with the
limits of self-reporting. Unlike other social activities, sexual
activities are private and reclusive. It is impossible for a researcher
to be present, to observe, or to participate in my informants'
sexual activities. However, although researchers have no other options
but to rely on informants' self-reporting, I have found ways to
enhance the reliability of the data. In my research, since I have
developed a close relationship with both the hostesses and their client
lovers and friends for a decade, I was able to corroborate their stories
and detect and account for inconsistencies or discrepancies in their
words and actions. Daily interactions with the hostesses and clients on
a casual basis throughout a whole year's intensive fieldwork, not
counting the previous two years of intense interaction, exposed me to a
wide array of information and knowledge, either from group gossiping or
through their family members that aided the verification process.

FROM ELITE TO ENTREPRENEURIAL MASCULINITY

The meanings of masculinity evolved throughout Chinese history.
Before the May Fourth Movement in 1919, courtesan house was a site that
produced an elite masculinity of self-control and cool demeanor. Elite
masculinities had to be validated by the courtesans, the arbiters of
their masculinity, as worldly, urbane, knowledgeable, sophisticated, and
refined (Henriot, 2001; Van Gulik, 2003). (5)

Concerns about masculine identity at this secure time of
"culturalism" (Fitzgerald, 1996) have to do with social class.
"Culturalism" entailed a universal superiority that Chinese
people felt at that time, considering themselves the "Middle
Kingdom"--the center of the world and universal superiority.
Fairbank states that China embraced an attitude of being the large
ethnocentric universe which "remained quite sure of its cultural
superiority even when relatively inferior in military power to fringe
elements of its universe" (Fairbank, 1973, p. 178).

With the Western intrusion into China, Chinese male insecurity was
linked to the perceived decline of China and contributed to the growth
of Chinese nationalism. Elite masculinity was attacked because it was
identified with the elite cultural tradition (Earson, 2002). Nationalism
produced a new model of masculinity. For the first time in Chinese
history, the sexual prowess of Chinese men was not measured internally
as a means to establish social class but came to be measured against the
outside predators whose military prowess identified them as more
sexually potent (see Brownell, 2000).

Later on, the Maoist state, with its emphasis on gender equality,
attempted to control men's sexuality by suppressing female
sexuality (Zheng, 2009). (6) In the 1990s, masculinity and marital
stability were seen as dependent on women's enjoyment of sex. This
radical notion that women should enjoy sex was not out of a concern for
the happiness of women, but rather reflected the new competitive
capitalist economic model where men proved themselves through
entrepreneurial activity. Chinese entrepreneurs, instead of taking
offense against the Taiwanese and Japanese businessmen who had taken
Chinese mistresses, simply emulated them and took mistresses themselves
(Brownell, 2000). While young entrepreneurial men recovered their
economic and sexual potency, older retired cadres were faced with
impotence (Brownell, 2000). So devastated was this group, there was an
upsurge in the market for tonics to reinvigorate their sexual life.
Here, the link between politics, economics, and sexuality is drawn. Men
with economic and political power become sexually potent, whereas men
who have lost such power feel emasculated by the market reforms.

Entrepreneurial masculinity has been analyzed as inextricably
linked to economic and state power (see Brownell, 1999, 2002; Chen,
2002; Connell, 2001; Gilmore, 1990; Louie, 2002; Jankowiak, 2002; Zheng,
2009; Zhong, 2000). (7) Men were judged not by birth status or even
education but by their competitive abilities. The impact of this change
on the relationship between men and women was profound. Because of the
risks and social trust needed in the alliance between entrepreneurs and
officials, the consumption of sex served as an institution for the
preselection test and bonding activities, which ensured social trust
(Zheng, 2006). The most powerful men were identified as those who could
emotionally and physically control the hostesses, exploit them freely,
and then abandon them. The less powerful men engaged in sex-for-money
transactions with a large number of hostesses. The weakest men were
those who became emotionally involved with the hostesses. Hence, in the
new, fluid urban entrepreneurial environment, men resurrected their lost
masculinity by emulating the economically successful Japanese and
Taiwanese businessmen in the consumption of women. Their subjugation of
women represented the recovery of their manhood in post-Mao China Women
became a testing ground for male entrepreneurial ability. In this
competitive world, men's skill in charming women and keeping them
under control came to define their success (see Zheng, 2009). Hence, in
the new fluid urban entrepreneurial environment, men attempted to rebel
against the Maoist control of their sexuality and resurrect their lost
masculinity by emulating the economically successful Taiwanese
businessmen in the consumption of women. "Masculinity is related to
state power, nationalist ideology, the free market, and the marriage/sex
markets. The current situation has unleashed an entrepreneurial
masculinity that is apparently proceeding hand in hand with the return
of male privilege and female disadvantage" (Brownell, 2000, p.
230). Their subjugation of women represented the recovery of their
manhood in post-Mao China. (8)

DEFIANCE AGAINST THE STATE AND PURSUIT OF ABSOLUTE SEXUAL PLEASURE

In Red Lights, Zheng (2009) analyzed the clients' metaphoric
use of liang (grain) in their reference to having sex with their wives
as "jiao gong liang" (turning in the grain tax). I detailed
how the history of the hierarchical system of food rationing in colonial
and Maoist Dalian placed the Japanese and Maoist states at the top of
the food chain and the men at the bottom. Meanwhile, men perceived their
masculinity as lost in the alliance of the Maoist state and Chinese
women to liberate women. In the post-Mao era, men's attempts to
recover their lost sexual identity with free-ranging promiscuity in the
karaoke bars were further curtailed by the continued presence of
socialist moralities and state laws. Thus, clients analogized turning in
their jing (semen) to their wives as peasants turned in the grain tax to
the state (Zheng, 2009). The clients/peasants perceived themselves at
the bottom of the hierarchy vis-a-vis the wives/state. The clients
operated on an economy of scarcity where the semen was perceived as
finite. The social stress of a lack of control was expressed in the
bodily symbolism in which they assumed more control over their
"limited" amount of semen. Self-perceived as the managers of
their bodily assets, the clients exercised what I called
"misappropriation;" that is, they allocated their semen
between their wives and hostesses. Such a misappropriation of their jing
(semen) was a mode of resistance, just as liang (grain) was
misappropriated by peasants who rebelled by cheating the government of
their taxes. The clients' subversive misappropriation was intended
to maintain their bodies' independence as "impermeable,
inviolable entities" (Brownell, 1995, p. 243; see also Brownell
& Wasserstrom, eds., 2002; Chen, 2002; Jankowiak, 2002; Louie, 2002,
2003; Zhang, 2001; Zhong, 2000).

This theme of clients' resentment and defiance against state
control of sexuality and pleasure continued throughout the current
research. Clients expressed their resentment toward the cultural
understanding of sex as evil and the state's need to restrict and
repress it. This echoes the traditional cultural values of "sexual
silence" between many men and women described in the Latino context
by scholars such as Carrillo (Carrillo, 2002; G6mez, & VanOss Marin,
1996). (9) As with many Latino people who have demonstrated a strong
favor for cultural change, clients in my research also vehemently voiced
their dissatisfaction with this cultural norm. Client Zhang said,
"Sex is sin in China. We are taught that sex is the first and
foremost evil among the ten thousands of evils. This Confucian idea is
still prevalent in people's minds." Client Zhang said that he
has never talked about sex with his wife because he was too embarrassed.
Other clients told me the same story. Client Jiang said, "In China,
no one likes to talk about it [sex]. Even with male friends, no one
talks about sex. Sex is still a taboo. I don't want to answer these
questions about condom use. I'll just say 'I don't
know' to handle these questions, not because I don't know, but
because I don't want to answer them." I thanked him for
telling me honestly his resentment toward the questions on condom use. I
then pressed him and said, "I understand that sex is a taboo and no
one likes to talk about it, but why did the male clients respond to this
topic with so much resentment? Why is the topic of condom use so
unpleasant to them?"

Client Jiang responded, "This is because of the conflict
between the mainstream which is conservative, and the personal and
private sphere, which is liberal. Just like the saying that goes,
'One Muslim can eat full, but two Muslims have to starve to
death.' One Muslim person can eat pork when alone and private, but
two Muslims will have to starve because of the taboo. This is the
conflict between the conservative mainstream and the liberal personal
sphere."

Here the story of Muslim was appropriated to demonstrate the
contrast between the government that repressed expressions of sexuality
and the clients who rejected the mainstream, and were hence censored,
controlled, and condemned. One might be justified in questioning client
Jiang's response since he was more than willing to talk about sex
when it allowed him to brag about his sexual exploits. As noted earlier,
performing emotional coolness and rational control over hostesses was
essential among clients because it reflected their trustworthiness and
rationality, the qualities that were put into test during sex
consumption before their admission into the male alliance (see Zheng,
2006). It was only after the topic of condom use and HIV/AIDS was
brought up that he was concerned with the distinctions between the
public and private sphere and claimed the fight of privacy.

Client Ren construed extramarital sex and hedonistic sexual
pleasure an active rebellion against government repression and a
liberating space from the suffocating repressive state. He continued:

This attitude, while not universal among the clients interviewed,
was representative of a large proportion of those who were willing to
speak on the subject. Client Ren's words vehemently criticized the
state ideology as useless and meaningless and pinpointed the detrimental
impact of such an empty state ideology on people, that is, a moral
vacuum and a lack of basic kindness to others. Such a moral vacuum drove
clients to explore their sexual urges and pursue their sexual liberation
as a voice of defiance and rebellion against the deceiving and
repressive state ideology.

Throughout the interviews during my research, clients stated again
and again that they resented condom use because it was just another
scare tactic that the government used to further repress their
sexuality. These interviews contended that the state's repression
and surveillance of individual private spheres instigated the
clients' resistance through sexual liberation. Such sexual
liberation not only included engaging in illicit sex with hostesses but
also entailed resentment against condom use.

Hyde argues that, in competing with the state family planning
apparatus, the market economy opens the door to new kinds of sexual
practices (Hyde, 2007). Certainly, the market economy has unleashed and
catapulted male clients' sexual revolution. About condom use, Hyde
argues that purchasing condoms in the market, compared with acquiring
condoms from the state, is more discreet and increases privacy, which
helps individuals resist state intrusion into their personal lives as
"everyday practices of resistance" (Hyde, pp. 160, 168). In
this particular aspect, male clients and hostesses in my research told a
different story. During this research, some male clients who purchased
condoms said that purchasing condoms in the market is a "public
act," involving a great embarrassment. For instance, one client
explained, "I am afraid of buying condoms. When I do, I drop my
head like a criminal who has just committed a crime, hastening to escape
after paying for the condom." Young unmarried women, such as
hostesses in my research, encountered stigmatizing comments from the
sales workers who called them sex workers. Although purchasing condoms
in the market is embarrassing, they still preferred the market to the
state apparatus because, as they remarked, the state-distributed free,
poor-quality condoms (too dry and easily broken), in limited quantities
(only ten free condoms a month), and for married couples only. The
difference between Hyde's research findings and the authors'
could result from the different research locations and disparate
research populations.

While Hyde concludes that the market "provides a potent weapon
against STDs and AIDS through the sale of condoms" (Hyde, 2007, p.
152), the story of male clients in this research points to a cultural
dimension that thwarts and undercuts the potency of this
"weapon." I define this cultural dimension as the perception
of condoms by male clients. To clients, condoms symbolized state
repression of sexual pleasure and state intrusion into the individual
private sphere. By talking about condoms, restrictions are put on male
clients' sexual pursuits and sexual pleasure. It reminds people
that the state interferes with and represses their sexual desires.
Hence, many clients regarded rejection of condoms as a political act of
defiance. This is one of the factors that shape many men's refusal
to use condoms.

Clients in my research rejected warnings about HIV/AIDS and
believed that inculcating fear of the disease is a strategy the state
uses to curb their free sexual expressions, which threaten the state.
AIDS and condoms represent exactly what they rebel against--control and
regulation of their sexual pleasure. Warning about AIDS and condom use
shackle their sexual pursuits and thwart their absolute enjoyment of
free sex. Their free pursuit of sexual pleasure poses a direct challenge
and menace to the state, and hence constitute the main target of state
control. As Foucault contends, "policing of sex is an important
component in maintaining the unmitigated power of the central
state" (Foucault, 1978, pp. 24-26). If sex can be regulated and
maintained within the confines of marriage, then social stability and
state control is ensured. Thus, it is essential that "the state
knew what was happening with its citizens' sex, and the use they
made of it, but also that each individual be capable of controlling the
use he made of it" (Foucault, p. 26). Reshaping and disciplining
sex is hence central to the state's desire to maintain and secure
the social fabric.

The post-Mao state has exercised many strategies to negate, to
silence, and to police non-marital sex. The state's obsession with
sex and with controlling it is seen as necessary to achieve what the
state envisions as a harmonious society, in which citizens are obedient
and the state is in control. Paralleling state control with condom use,
clients' sentiment is analogous to the gay community in their
sexual revolution during the early 1980s. When little was known about
AIDS, the gay community in the San Francisco area was unreceptive to
attempts by local government and medical institutions to promote safe
sex or condoms and to discourage high-risk behavior like anonymous sex
in bathhouses (Shilt, 2000). These educated efforts were largely
thwarted by the history of misunderstanding and outright prejudice that
had existed between the gay community and the American medical
establishment. Before the AIDS outbreak and outreach programs,
homosexuality was defined by the medical establishment in general and
psychiatry in particular as mental illness (APA, 1973). (10) This view
of sexual orientation as a pathological behavior caused homosexual
groups to distrust government and medical agencies so that people like
Michele Foucault believed that AIDS was designed to further stigmatize
homosexuality (Halparin, 1995). It was not that Foucault did not have
the facts, but rather, it was the inseparable relationship between
medicine and, in this case, politics, history, and power that led to the
unchecked spread of AIDS in the early period and the tragic loss of
life.

Clients held similar kinds of resentment against the state's
regulation of their pursuit of sexual pleasure and expressed an outright
hostility to HIV/AIDS and condoms. As a result of their cultural
perceptions of condoms, knowledge of HIV/AIDS is not conducive to
protective sexual behavior and condom use.

FEARLESS AND VALIANT CLIENTS

Clients' health practices are not only shaped by their
relationships with the state, but also informed by their perception of
entrepreneurial masculinity as fearless and valiant. Their audacity in
taking risks and their consideration of diseases as "bad luck"
remind us of the notion of "edgework" analyzed by Collison
(1996). While young men in Collison's research occasionally
"lived on the edge" to transcend the banality of everyday
existence, clients in my research enacted this kind of fearless
entrepreneurial masculinity on a daily basis.

During my research, I asked each interviewee the following
question: "What do you think of your male friend who does not use
condoms with hostesses?" The common response I received was,
"I think he is very valiant (meng). You know, very brave, fearless,
has the courage to take risks." Their responses showed that clients
attempted to project a brave and valiant (meng) persona for the peer
group through abjuring condom use.

Here, the idea of "valiant," or "virile," is
similar to the meaning of masculinity in other cultures, such as in
Africa and in Latin America. In South Africa for instance,
flesh-to-flesh sex with multiple sexual palmers is valorized, and condom
use is seen as undermining South African men's notions of
masculinity (Holland et al., 1994a&b; McGrath, 1993), fertility
(Abdool et al., 1992), and pleasure (Preston-Whyte et al., 1991).

Clients in my research demonstrate entrepreneurial masculinity
through engaging in illicit sex with multiple sexual partners, not
wearing condoms, and not fearing STDs, while imposing control over
hostesses. Peer norms among clients valorize macho displays of a
fearless spirit and the pursuit of absolute sexual pleasure and prevent
them from protecting their health.

When I asked one client if he was afraid of getting STDs, he
responded, "Not at all." When I asked him why, he smiled and
said, "Well, even if you just drink cold water, you may get
something trapped in your teeth. Not every hostess has disease. If it
just so happens that the hostess you sleep with has disease, you have to
acknowledge that you have had bad luck. You'll have to say, well, I
happened to meet such a hostess. I have nothing to say but to recognize
my bad luck!" Similarly, another client said, "Not every
hostess has disease. Every day you see other people sleeping with
hostesses without condoms and they have not caught any diseases. You
know that it's your bad luck if you catch it once in a while."

Catching diseases from illicit sex is portrayed by clients as a
matter of luck and chance. Conceptualizing health as a matter of luck or
fate "may be psychodiscursive practices mobilized to help people
through difficult material circumstances and a mechanism for allowing
the separation of illness, impairment and death from individual
blame" (Robertson, 2007, p. 60). While clients' notions may
resemble the fatalistic views on health by men in other research
(Donovan, 1986; Howlett, Ahmad, & Murray, 1992; Robertson, 2007), I
believe there is a difference. The men in other research are from the
lower socio-economic strata whose control over their lives is marginal
(Donovan; Howlett, Ahmad, & Murray; Robertson, 2007). A fatalistic
belief system more accurately represents reality for them and may better
allow them to accept their lack of control. For the upper middle class
men in my research however, it seems more likely that the fatalistic
worldview is a romantic pretense meant to enhance their masculine
identity.

It was important to clients in my research to portray themselves as
fearless risk-takers in their attitude toward STDs. Clients asserted
that they did not care about STDs because so many people got them and
one shot was enough to treat the infection. One client said, "Did
you see how many people queue up in the municipal STD hospital every day
to be treated for venereal diseases? Tons of people! So no one feels
embarrassed about having venereal diseases."

This dialogue demonstrates the need for these men to conform to
this new rebellious group identity, which defines them as real men.
Whatever these men's real fears might be, they are attempting to
project a certain kind of masculine image to me as an interviewer.
Clients in my research tend to take venereal diseases lightly because it
is not only easily treatable but also something shared by their male
friends. As they expressed throughout the interviews, a valiant man is
not timid; a valiant man does not worry about taking risks; a valiant
man is fearless of STDs. In fact, as a client told me, his friends
"took it so lightly that they were even trying to hook up with
hostesses in the STD hospital when they were queuing to see the
doctor."

CONCLUSION

In their chapter on men, masculinities, and health, Robertson and
Williams (2009) contend that "Very little work to date on
men's health promotion identifies the significance of socially
structured factors as determinants of men's health
practices/outcomes and therefore seeks social/political rather than
individually based interventions" (p. 58). In addressing the ways
in which men's health practices are impacted by the social factors
of entrepreneurial masculinity and social relationships with the state,
this research has significant implications for HIV intervention
programs, which should be devised to alter men's health practice
through breaking the association of condoms with authoritarian,
top-down, and coercive family planning programs and changing peer
culture, peer behaviors, and peer worldviews in men's workplaces
including companies and government offices in China.

In addition to the practical implications for HIV/AIDS
intervention, this paper also contributes to the current theoretical
knowledge on men, health, and masculinities in three ways. First, this
paper demonstrates the changing nature and complexity of masculine
identities rather than taking it as an immutable entity or an unchanging
norm. The concept of masculinity, as the paper illustrates, is
historically evolving. It changes, evolves, and takes on different
meanings and embodiments according to different historical eras. In
China, during the imperial time, elite masculinities were defined as
worldly, urbane, knowledgeable, sophisticated, and refined. In the
1990s, the most powerful men were identified as those who could
emotionally and physically control the women they consume, exploit them
freely, and then abandon them. The less powerful men engaged in
sex-for-money transactions with a large number of women. The weakest men
were those who became emotionally involved with women. In the new, fluid
urban entrepreneurial environment, men attempted to rebel against the
Maoist control of their sexuality and resurrect their lost masculinity
by emulating the economically successful Japanese and Taiwanese
businessmen in the consumption of women. Their subjugation of women
represented the recovery of their manhood in post-Mao China.

Second, this paper contributes to the literature of gender and
health by demonstrating the ways in which conceptualizations about
masculinities inform and impact on men's health-related activities.
Men's voices and narratives reveal a complicated relationship
between masculinities and health-related activities in everyday life
that involves their negotiations and resistances against the repressive
state. I believe the proper interpretation of their voices also contests
a reductionist approach that views men as inherently careless about
their health and physical wellbeing.

Because condoms symbolize state repression of sexual pleasure and
state intrusion into individual private spheres and hence a loss of
masculine control, clients sought to rebel against the restrictions on
their sexual pursuits and achieve masculine liberation. Such sexual
liberation was multi-layered. It not only entails resentment against
condom use and engagement in illicit sex, but also necessitated complete
flouting of mainstream moralities and pursuit of absolute sexual
pleasure. It is also characterized by a care-free posture in the male
culture that regards clients' own pleasure, virility, and control
over women rather than the welfare of women.

Third, this ethnographic, in-depth study of men's lived
experiences sheds light on the nexus between masculinities and
men's health and furthers the current work on gender and health
that is still lacking in empirical data.

Future research needs to recognize the complexities in the
relationship between health-related activities and other aspects of male
identity in different configurations of social class and ethnicity.
Consuming services of women in karaoke bars is only one model of Chinese
masculinity, and not all men subscribe to it. As one might suspect, men
find masculine identities through other kinds of venues and sports such
as soccer, golf, and bowling, and through conspicuous consumption of
clothing, automobiles, and elegant housing. As Robertson points out,
there has been a move in studies of men's health from
"theorizing masculinity in the singular to masculinities,"
which "gives recognition to the multiple ways men live out
masculine gender identifies, as well as growing recognition of
intersecting aspects of masculine identities" (Robertson, 2009, p.
13). Future research needs to take this approach into other areas of
men's experiences and consider how different aspects of male
identities interact and impact on health practices (see also Robertson,
2006).

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(1) Although karaoke bars are legal, they have always been one of
the government's main "culture purging" targets. It is
claimed that they work against the state's cultural logic in three
aspects: (1) Socialist business should prioritize the needs of people
and serve the people. It should be different from the commercial system,
where the pure objective is to pursue and procure sudden huge profit.
Many bar bosses operate their business by cheating customers and
providing erotic services. (2) "Erotic company" (seqing
peishi) is illegal and immoral and runs counter to socialist
"spiritual civilization." Such "ugly phenomena"
associated with capitalism should be wiped out to maintain the healthy
and inspiring socialist cultural environment and "civilized
consumption." (3) Juxtaposed against socialist recreations enjoyed
by the masses, karaoke bars are more individually based, places where
individuals pursue and express their "repulsive and hideous"
desires to show off their performing talents and satisfy their sexual
demands. In view of these reasons, karaoke bars regularly undergo a
purging process to become part of "spiritual civilization."
Frequent police raids are part of this process.

(2) These authors argue that we should integrate varied
sociocultural factors and male diversity in health-related activities in
order to shed light on the relationship between men and health.

(3) In his study of men and health in the U.S., Courtenay points
out that men tend to engage in risky behaviors and less healthy
lifestyle patterns (Courtenay, 2000). He argues that in the U.S., forms
of masculinities, enactments of gender, and institutional structures
contribute to health risks. Men engage in certain behaviors to display
the hegemonic masculine ideals (Connell, 1995). Courtenay notes that it
is not only hegemonic masculine ideals, but also power and prestige that
men attempt to procure through appropriating behaviors that are
detrimental to their health (Courtenay). Through these risky and harmful
behaviors that include suppression of pain, denial of health needs,
sexual aggression, physical dominance, violence, sexual conquest, denial
of physical discomfort, and disregard of physical pain, men embrace
risks, reject femininity, exhibit fearlessness, and perform their
masculinities that disregard health. Those who fail to do so risk being
ridiculed and relegated to inferiority and hence lack of power and
prestige. These activities that define and enact masculinity are
informed, shaped, and upheld by cultural norms and institutional
structures that reward men with money, power, and prestige (Courtenay).

(4) Interview questions also focused on the use of alcohol in their
sexual interactions; their perception of the beginnings of a sexual
relationship; their views about who should initiate a sexual
relationship and how they communicated with their partners about their
likes and dislikes during sex; what told them that an interaction was
sexual; their understanding of safe and unsafe sex; their views about
whether there were differences between sex behaviors with a wife and
with a prostitute or a lover; whether they carried condoms; whether
their partners had condoms available; whether they assessed the dangers
of disease before engaging in sex; assessment of education and social
class as a basis for trust; which party normally spoke about protection;
where they obtained condoms when they needed them; what prevented them
from asking for a condom in an encounter; what had happened to them when
they had asked for protection; how emotional involvement related to use
of protection; and so on.

(5) Courtesan houses or public places where courtesans were
summoned as professional entertainers formed an integral part of the
official and business routine where social relations of officials,
literati, artists, and merchants were conducted. Every official
entertained his close colleagues--superiors and inferiors and
merchants--to conclude or to negotiate deals. An official could ensure
his promotion by introducing his superior or an influential politician
to a discreetly chosen courtesan, and by the same means, a merchant
could obtain a much-needed credit or an important order.

(6) Before liberation, men could gain economic and political power,
but in the Maoist society, they were stuck in socialist work units
earning the same meager wages as women. The party-state constantly
watched over them, stifling their personal ambitions and prohibiting
them from speaking their own minds. That led to men's feminization
and lack of initiative and creativity. It was believed that the Maoist
state's alliance with liberated women stifled men's ability to
discover their own strength and led to their feminization.

(7) David Gilmore's cross-cultural study of various
masculinities and R.W. Connell's call for both international and
local approaches to the study of masculinity have generated much
interest. Zhong Xueping and Kam Louie examine masculinity through
in-depth readings and intricate analysis of Chinese films and literary
works that were produced throughout the crucial historical junctures in
China. Zhong utilizes a feminist psychoanalytic lens to argue that
Chinese men feel "besieged" in post-Mao China and attempt to
negotiate an image of strong men vis-a-vis women and the state as a part
of the effort to create a geopolitically strong Chinese nation. Kam
Louie traces the historical changes of the dyad wenwu (cultural
attainment-martial valor) and argues that this dyad is an analytical
tool and theoretical construct facilitating the conceptualization of
Chinese masculinities. Brownell and Wasserstrom's edited book takes
an anthropological and historical approach to evoke how femininity and
masculinity in China are mutually constructed and have changed over
time.

(8) My ethnography of the karaoke bars (Zheng, 2009) not only
displays the kind of entrepreneurial masculinity sought there but also
demonstrates the responding femininity performed there. I argue that the
hostesses take advantage of the clients' use of them and perform an
obedient and promiscuous role to satisfy the clients. In return,
hostesses redistribute the clients' social and economic resources
and claim for themselves a cosmopolitan image.

(9) Scholars have emphasized the prevalence of "sexual
silence" in Mexican culture and Latin culture (Carrillo, 2002;
Gomez & VanOss Marin, 1996). Sexual silence refers to the phenomenon
in which individuals are acculturated to avoid talking openly about sex
and maintain indirect and veiled communication about sex. As Carrillo
notes, it is a "widespread method used to keep transgressive sexual
behavior under wraps in order to maintain the appearance of normality.
They [people] indeed discovered how one can transgress and
simultaneously comply with cultural expectations, how nonnormative
behaviors can be carried out without triggering negative social
consequences. This included, as well, learning that certain forms of
sexual joking were allowed in order to refer to sexual matters in good
company or to safely express interest or desire to potential sexual
partners" (Carrillo, 2002; Gomez & VanOss Marin).

(10) The American Psychiatric Association (APA) removed
homosexuality from its official Diagnostic and Statistical Manual of
Mental Disorders (DSM) in 1973.

TIANTIAN ZHENG, PH.D. *

* State University of New York, Cortland.

The author would like to acknowledge the incisive and constructive
suggestions and comments made by the editor Steve Robertson and
anonymous reviewers that have greatly improved the quality of the paper.

Correspondence concerning this article should be addressed to
Tiantian Zheng, State University of New York, Cortland, NY 13045. Email:
tiantian.zheng@cortland.edu

Police often attack sauna bars and karaoke bars to arrest those who
sleep with hostesses unless the manager is a friend of the police.
Some of my colleagues were dismissed from their positions because
they were caught by the police sleeping with hostesses. College
students can be dismissed from schools for engaging in sexual
activities. It's only recently that college students have been
allowed to get married--the policy has only started to open up
recently. All these behaviors run against the mainstream and they
are the target of expulsion and punishment. That's why in personal
space people can be very open and liberal, but they're not willing
to talk about it in public. It's because of this conflict. This
conflict forces people to appear conservative and traditional.

There was a thought in the past--communism. It was communism that
guided people to do everything. Today this thought is no longer
useful. It is of no use in the society; it is of no use in the job.
It lost its function as guidance. It lost its meaning. Because
China doesn't have any religions like other countries. China
doesn't even have the simplest principle of being kind to others
[yuren weishan]. People lost their directions and embraced all the
new things. I lack an understanding of these new things. All I know
is that the basic nature of human beings is evil [renzhichu,
xingbene]. I have this sexual urge; I need sexual satisfaction; and
hostesses can offer it.